SMARTY PANCE Women's Health

SMARTY PANCE Women's Health Frothy, clear - white or yellow-green to gray adherent vaginal discharge, dysuria, vaginal pruritis. Vulvar and cervical erythema. Flagellated protozoa - Trichomonas What is the most common cause of secondary amenorrhea? - Pregnancy *Prolapse of the rectum* into the back wall of the vagina - Rectocele HCG, TSH, Prolactin. Progesterone challenge. - Amenorrhea Fishy odor, Thin grayish vaginal discharge, Clue cells - Bacterial vaginitis; Gardnerella vaginalis Anovulation. Coagulation disorder. OCP - DUB What are the two most common causes of secondary amenorrhea in patients with normal estrogen? - Asherman syndrome and polycystic ovarian syndrome *Prolapse of the bladder* into the front wall of the vagina - Cystocele What is the most likely disorder in a bleeding pregnant patient with an extremely elevated beta HCG? - Gestational Trophoblastic Disease What do a lecithin to sphingomyelin ratio 2:1 and presence of the pulmonary surfactant phosphatidylglycerol represent? - Fetal lung maturity Low-dose combination oral contraceptives must be stopped in a smoker at age - 35: After age 35, the associated risks of smoking and oral contraceptive use for deep venous thrombosis, cerebral vascular accidents, and myocardial infarctions are increased significantly. The patient should be counseled on estrogen-free methods of contraception. What is another name for gonadal dysgenesis? - Turners syndrome Risk: Obesity, anovulation, Nulliparity, FHX, Post menopausal bleeding = biopsy. Endometrial stripe 5 mm - Endometrial Cancer "Thick white vaginal discharge, hyphae & buds on KOH prep" - Candida Postmenopausal, dyspareunia, thin vaginal discharge, atrophic vulvar changes, vaginal petechiae - Atrophic vaginitis; Tx = topical estrogen chocolate cyst. Chronic pelvic pain. laparoscopy. OCP. leuprolide - Endometriosis What lab test is diagnostic for menopause? - FSH 30mIU/mL The "gold standard" for diagnosis of abnormal uterine bleeding is - Uterine Dilation and Curettage Especially when done with hysteroscopy, uterine dilation and curettage can be diagnostic and therapeutic List the 4 antihypertensive drugs used in pregnancy. - Alpha-methyldopa - Hydralazine - beta blockers - Calcium channel blockers Estrogen/progesterone dependent. Shrink at menopause. - Leiomyoma what is the incidence for dizygotic (fraternal) twins in the United States? - 1 in 90 The incidence of dizygotic (fraternal) twins within the United States is approximately 1 in 90 pregnancies; it is slightly higher in African Americans and is lower in Caucasians What does the term procidentia of the uterus refer to? - Complete prolapse of the uterus What is the incidence for monozygotic (identical) twins in the United States? - 1 in 250 The incidence for monozygotic (identical) twins is approximately 1 in 250 pregnancies. What is the recommended treatment for syphilis in a penicillin allergic pregnant patient? - Desensitize and treat with PCN Early satiety and bloating. Complex Cyst. CA-125. BRCA-1/2 - Ovarian Cancer 20yo female w/ rubbery, firm, well- circumscribed, non-tender breast lesion, doesn't change w/ cycle - Fibroadenoma Pap 21 every 3 years. HPV 16 and 18. - Cervical Cancer What is the most common gynecological cancer? - Endometrial cancer (adenocarcinoma) A breastfeeding woman presents 3 weeks postpartum complaining of unilateral breast pain, fever of 102°F, and chills. Breast examination shows an erythematous right breast with a palpable mass, induration, erythema, and tenderness to palpation. The most likely diagnosis is: - Infectious mastitis Onset of infectious mastitis is 1 week postpartum. Treatment of choice is cloxacillin, dicloxacillin, nafcillin, or a cephalosporin. The mother should continue to nurse or pump and use warm soaks and oral pain relief What is the recommended treatment for syphilis in a penicillin allergic non pregnant patient? - Oral doxycycline or azithromycin 30 - 50yo female, painful, multiple, bilateral breast masses that increase in pain and size before menses - Fibrocystic breast disease What is the cardinal symptom of endometrial cancer? - Vaginal bleeding During which interval in pregnancy to should patients be screened for gestational diabetes? - Between 24 and 28 weeks gestation The American College of Obstetricians and Gynecologists recommends that pregnant women at low risk for gestational diabetes mellitus have a glucose tolerance test between 24 and 28 weeks of gestation because, by this point, the condition has manifested and can be detected. List the "3D's" of endometriosis symptoms. - Dyspareunia - Dyschezia - Dysmenorrhea A woman presents to the emergency department 10 weeks after the first day of her last menstrual period complaining of bright red vaginal discharge. She denies abdominal cramping. Physical examination discloses blood in the vaginal vault, closed cervix, without evidence of passage of tissue. Which type of abortion does this represent? - Threatened abortion A threatened abortion is characterized by bleeding ranging from spotting to profuse, brown to bright red, occurring before 20 weeks of gestation. Pelvic examination discloses blood in the vaginal vault with evidence of bleeding from the cervical opening, a closed and uneffaced cervix, and no evidence of the passage of tissue. Premature ovarian failure is defined as the onset of menopause less than _?_ years old. - 40 years old Spontaneous bloody, serous, or cloudy nipple discharge - Intraductal papilloma Green frothy discharge. Strawberry cervix - Trichomoniasis Breast mass, nipple retraction, bloody nipple discharge - Breast cancer (mass is most common presenting clinical manifestation) What are the most common ovarian growths? - Cysts Clinical breast examination should be performed by a clinician at what time of the menstrual cycle? - Days 5 to 7 of the menstrual cycle Less fluid retention and hormonal influence is present in the breast tissue 5 to 7 days into the menstrual cycle, allowing for a better and more thorough examination. Breast tissue may retain fluid and therefore be more difficult to examine at the onset of menses. Hormonal influence may affect the breast tissue during ovulation and during days 8 to 25 of menstrual cycle. Hormonal influence and fluid retention may affect the breast tissue during days 16 to 25 of menstrual cycle. Which hormone is dominant in the luteal phase of menstruation? - Progesterone Preterm labor is defined as occurring before _____ weeks gestation? - 37 Preterm labor is characterized by regular uterine contractions, abdominal examination disclosing a gravid abdomen before 37 weeks of gestation, cervical effacement, cervical dilation, and/or descent of the fetus into the pelvis. Which hormone is dominant in the follicular phase of menstruation? - Estrogen Overweight, irregular menstrual cycles (poss. Amenorrhea), elevated blood sugar, hirsutism - PCOS (stein-leventhal syndrome) 51y /o. Elevated FSH. HRT: Give progesterone to protect uterus - Menopause "Adolescent female with midcycle pain alternating from left to right side. Relieved w/ NSAIDs" - Mittelschmerz Mammogram 50. BRCA-1/2. Biopsy. Positive receptors = tamoxifen - Breast cancer A serum quantitative human chorionic gonadotropin (hCG) assay can detect the presence of hCG as early as ____ days after conception - 5 days A serum quantitative human chorionic gonadotropin (hCG) assay can detect the presence of hCG as early as 5 days after conception. A urinary pregnancy test detects hCG 14 days after conception Prolactin - Galactorrhea The best diagnostic study for management of uterine leiomyomas is: - Pelvic ultrasound Most common causes of post partum hemorrhage? - Uterine atony (laceration is the second most common cause) What are the classic clinical features of ectopic pregnancy? - Abdominal pain and bleeding The typical presentation of a patient with an ectopic pregnancy is abdominal pain and vaginal bleeding. Firm irregular shaped, NONTENDER enlarged uterus - Leiomyoma How is infertility of polycystic ovarian syndrome treated? - Clomiphene or Metformin Chlamydia and gonorrhea. Cervical motion tenderness. Pelvic pain. - PID Softened, tender, diffusely globular uterine enlargement - Adenomyosis When is Cervical itraepithelial neoplasia (CIN) most common to occur? - Women in their 20s When should Rh immune globulin (RhIG) be given to a mother - Administration of Rh immune globulin (RhIG) at 28 weeks or at times when there may be a transfer of blood with mother and fetus in the Rh-negative mother with Rh-positive father is used to prevent hemolytic disease of the newborn. Prevention in mother: 200 ug RhoGam (RH immune globulin - pooled anti-D IgG binds to fetal RBCs to prevent maternal mixing). Given if Rh negative mother and father Rh positive or unknown. Given at 28 weeks gestation after potential mixing of blood. Also given within 72 hours of delivery of Rh positive fetus. What is McRobert's Maneuver? - Used to manage shoulder dystocia during delivery of the infant. Maternal legs are removed from stirrups and sharply flexed upon the abdomen. When is APGAR score assessed? - At 1 min and 5 min after birth (Normal score is 7-10 - Score of 7 needs to be evaluated further) Fallopian tube.Positive pregnancy test, vaginal bleed, pelvic pain, cervical motion tenderness. IUP seen when HCG 2,000 - Ectopic Pregnancy 6cm unilateral, mobile, tender adnexal mass - Tubo-ovarian abscess Naegele's rule: - LMP + 7 - 3 mo What kind of cancer are women exposed to diethylstilbestrol (DES) at increased risk for? - Clear cell adenocarcinoma What are the 5 APGAR assessments in the newborn? - Activity (muscle tone) - Pulse - Grimace (reflex irritability) - Appearance (skin color) - Respirations When should the pregnant patient be screened for Group B Streptococcus (GBS)? - 35-37 weeks GBS is caused by the pathogen Streptococcus agalactiae and is typically asymptomatic in the pregnant patient. Left untreated newborns can become infected and develop septicemia, pneumonia and meningitis. Women nearing delivery at 35-37 weeks should be tested and treated prophylacticaly for positive cultures to prevent neonatal infection. In the case of premature rupture of membranes and preterm labor, women should be treated prophylacticaly, ideally within 4 hours of labor. What bug most commonly causes mastitis? - S. Aureus 20 weeks - Chronic hypertension Pregnant + rash, post-auricular or occipital LAD - Rubella. Give vaccine AFTER delivery 20 weeks. No end organ damage or proteinuria. Labetalol and methyldopa - Gestational HTN What is the antibiotic of choice for mastitis? - Penicillinase resistance antibiotics (dicloxacillin) Risk factor for fetal genetic disorders? - Maternal age greater than 35 years, previous pregnancies affected by abnormalities, history of early pregnancy loss and ethnicity have all been associated with increased risk of genetic abnormalities. Additionally, paternal age of greater the 50 years has been associated with higher risks. Patients with severe eclampsia may develop HELLP syndrome. What does HELLP stand for? - Hemolysis - Elevated Liver enzymes - Low Platelets Preeclampsia + seizure. Magnesium - Eclampsia What is the most frequent benign condition of the breast? - Fibrocystic Breast Disease When should a serum triple screen (AFP, hCG, PAPP-A) be offered to a pregnant female? - Between 15-18 weeks gestation How do you cure a woman with preeclampsia? - Delivering the fetus will cure preeclampsia What genetic disorder does a serum triple screen test for? - Trisomy 21 (Downs Syndrome). A serum triple screen includes assessment of Alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG) and pregnancy-associated plasma protein A (PAPP-A). This test is used to screen for Trisomy 21 (Downs Syndrome). What benign breast lesion is more common in black woman? - Fibroadenoma Pregnant 20 wks gestation w/ vaginal bleeding, abd & pelvic pain. Blood from closed cervical os. - Threatened abortion What is the most common cancer in woman and what kind is the most common? - Breast, Infiltrating ductal carcinoma A pregnant female at 12 weeks gestation presents with a 7 day history of mild vaginal bleeding. Over the last 2 days she describes increased uterine cramping with vaginal discharge and bleeding. Denies passage of conceptus. Physical examination reveals ruptured membranes, moderate effacement of the cervix and cervical dilation of 4cm. What is the most likely diagnosis? - Inevitable abortion Inevitable abortions present with a bleeding history of several days , uterine cramping, rupture of membranes, cervical dilation 3cm and effacement with no expulsion of the products of conceptio Pregnant 20 wks gestation w/ vaginal bleeding, abd & pelvic pain. Tissue at or said to be passed from open cervical os. - Incomplete abortion (complete abortion will have empty uterus, complete passage of fetal tissue, pain resolves after passage of tissue) What ductal carcinoma presents with eczematous lesions of the nipple? - Paget disease What vaccines should always be avoided during pregnancy? - All live vaccines (e.g. MMR and Varicella) 37 weeks - PROM Pregnant woman who drinks during pregnancy and inadequate peri-natal care - Fetal alcohol syndrome - low birth weight A pregnant female at 16 weeks gestation presents with an incomplete abortion and continued bleeding. What is the most appropriate clinical intervention for this patient? - Dilation and evacuation An incomplete abortion is the expulsion of part of the products of conception. A dilation and evacuation is necessary to remove the remaining products. What is the best screen test for breast neoplasms? - Mammography The drug of choice for the medical management of unruptured ectopic pregnancies that are ≤ 4cm is: - Methotrexate Methotrexate is given as multiple dose, single dose or 2-dose therapy as medical treatment for the termination of unruptured ectopic pregnancies. What 4 markers are screened in the pregnant female in the Quad screen? - Maternal AFP - Estriol - HCG - Inhibin A Postmenopausal vaginal bleeding - Endometrial Ca - do endometrial biopsy What is the most effective form of contraception? - Oral contraception Tocolytic agent used in the treatment of pre-term labor to suppress uterine activity. - MgSO4 Magnesium sulfate is a tocolytic agent used in the treatment of pre-term labor to suppress uterine activity. What 3 markers are screened in the triple screen test to look for potential birth defects? - Maternal AFP - Estriol - HCG Individuals presenting with pre-term labor should be managed with _________ therapy to suppress uterine activity and __________ to accelerate fetal lung maturity if there are no contraindications for use. - Tocolytics, corticosteroids Pre-term labor should be managed with tocolytic therapy to suppress uterine activity. Magnesium Sulfate and β-adrenergic agonists (terbutaline) are most commonly used. In addition, a single course of antenatal corticosteroids (Betamethasone or Dexamethasone) can be administered to accelerate fetal lung maturity. What is the black box warning for IM depo injections? - Osteoporosis ñ thus only to be used for 2 years Postmenopausal adnexal mass - Ovarian Ca What is the most common cause of infertility? - Ovulatory disorders What lab test is used to diagnose premature rupture of membranes? - Nitrazine strip test and/or fern test on slide What is the physical exam finding of pelvic inflammatory disease (PID)? - Chandelier sign What constitutes a normal result after a 50-g glucose tolerance test - Results 140mg/dL are normal and require no further evaluation or treatment. If the results are 140mg/dL an OGTT should be obtained to confirm the diagnosis of gestational diabetes. If 2 out of 4 of the blood sugar levels are elevated in the OGTT, patients will require careful treatment to include dietetic counseling, exercise and many times, pharmacologic therapy. Pharmacologic therapy of choice is insulin. Which placental disorder presents with painful vaginal bleeding uterine contractions and fetal distress? - Abruptio placenta Where should the uterus be at 20 weeks of gestation? - Umbilicus Define Abruptio Placenta. - Premature separation of the placenta from the uterine wall Which placental disorder presents with painless vaginal bleeding? - Placenta Previa When should we hear fetal heart tones (FHT)? - 10 weeks What is bluish discoloration of the vagina and cervix called that is seen in pregnancy? - Chadwick sign A female at 32 weeks gestation presents with sudden onset of vaginal bleeding and abdominal pain. She is a cigarette smoker. What is the most likely diagnosis? - Painful vaginal bleeding in the 3rd trimester is most likely abruptio placentae. Cigarette smoking is a risk factor. Placenta previa, which can also cause vaginal bleeding is usually asymptomatic Implantation of placenta over the cervical os is called? - Placenta Previa Where are most ectopic pregnancies located? - Fallopian tube A patient develops increased vaginal bleeding following an unremarkable vaginal delivery. The uterus feels soft and boggy. What is the most common cause of postpartum hemorrhage? - Uterine atony is the most common cause of post partum hemorrhage and is characterized by a soft/boggy uterus Treatment for Rh incompatibility? - RhoGAM (Rh Immune globulin) at 28 weeks gestation and postnatally in non-sensitized patient What is the most common cause of ectopic pregnancy? - Adhesions What mother/father blood types may lead to Rh incompatibility? - Rh - (negative) mother with an Rh + (positive) father Non surgical treatment modality for uterovaginal prolapse? - Pessary placement A pessary provides structural support for the uterus. Define the type of abortion? No symptoms no cervical dilation in female less than 20 weeks gestation no heartbeat seen in gestational sac. - Missed abortion What is the most common complication of shoulder dystocia? - Brachial plexus injury (Erb's palsy) The most common complication of shoulder dystocia is Erb's palsy. What hCG level should show evidence of an IUP? - 1,500 mU/mL What patients should receive RhoGam with an abortion? - Rh-negative woman What is the most common cause of postpartum fever/sepsis? - The most common cause of postpartum fever/sepsis is endometritis. Define the type of abortion? Less than 20 weeks gestation with vaginal bleeding some tissue in vagina tissue in the uterus and dilated cervix. - Incomplete abortion Common, short-lived period of feeling sad, weepy or otherwise moody that is self limiting and resolves within 2 weeks after giving birth - "baby" blues 70 percent of new moms suffer from the baby blues—a normal, short-lived period of feeling sad, weepy or otherwise moody that is triggered by hormonal changes after giving birth Define the type of abortion? 20 weeks gestation with vaginal bleeding and no cervical dilation. - Threatened abortion What is the most common cause of non-congenital malformation deaths in a neonate? - Preterm delivery What is the most common fetal malpresentation? - Breech Statistically, breech presentation is the most common malpresentation. What is the most likely Dx? Young female with no intrauterine pregnancy by US and elevated beta HCG. - Ectopic pregnancy Risk factors for the development of postpartum fever/sepsis? - - C-section delivery - Multiple vaginal exams - Prolonged labor - Long duration of rupture of membranes What is a major risk factor of premature rupture of membranes? - Infection What test can confirm rupture or membranes and spilling of amniotic fluid? - Nitrazine paper and the fern test Recommended screening for cervical cancer begins at age? - 21 Guidelines recommend testing every three years for women ages 21-65; routine cervical cancer screening for women under 21 and over 65 is no longer recommended. A new five-year screening interval for women ages 30-65 when screened with a combination of Pap testing and human papillomavirus (HPV) testing. What is administered to enhance fetal lung maturity if under 34 weeks gestation? - Betamethasone Which of the following prenatal vitamins has been shown to decrease the risk of neural tube defects? - Folic acid Folic acid given daily has been shown to effectively reduce the risk of neural tube defects. It should be started 1-3 months prior to pregnancy. Preferred treatment for gestational diabetes? - Insulin Name the 7 Cardinal stages of labor? - Engagement of the head - Descent - Flexion - Internal rotation - Extension - External rotation - Expulsion Treatment for Thrichomonas - Metronidazole 2 g single dose What is the most common risk factor for pre-eclampsia? - Nulliparity Muco-Purulent vaginal discharge gram-negative intracellular diplococcus - Gonorrhea Common side effects of emergency contraception? - Nausea - Vomiting - Irregular bleeding - Headache - Breast tenderness - Fatigue What is the first line medication to decrease the risk of seizure in mild pre- eclampsia? - magnesium sulfate (MGSO4) What BP medication should be given to decrease the BP in a pregnant woman? - Hydralazine or labetalol Treatment for Gonorrhea - Ceftriaxone 250 mg IM in a single dose PLUS treatment for chlamydia (azithromycin 1 g PO single dose or doxycycline 100 mg PO BID for 7 days) Emergency contraception is available over the counter provided the patient is at least ______ years old? - As of April 2016 there is no age restriction What is administered to Rh-negative Moms at 28 weeks? - Rho-Gam Treatment for Chlamydia - Azithromycin 1 g PO single dose or Doxycycline 100 mg PO BID × 7 days What medication is used in the emergency contraception pill? - Levonorgestrel What is the test to measure fetomaternal hemorrhage? - Kleihauer-Betke (KB) stain Treatment of incompetent Cervix - Treated with cervical cerclage placed at 14-16 weeks and removed at 36 weeks to allow for delivery Name the emergency contraception which is available over the counter? - Plan B and its generic forms Take Action, Next Choice One Dose and My Way) are approved for unrestricted sale on store shelves. How often is Depo Provera injection required for contraception maintenance? - Every 12 weeks What is the condition that develops if Rh-incompatibility leads to severe fetal anemia and death? - Fetal hydrops Clumpy or cheesy vaginal discharge, pruritus, dysuria, burning, dyspareunia, vaginal or vulvar edema and erythema, PH 4.5 - Candidal Vaginitis What is the major symptom in abruptio placenta? - Painful vaginal bleeding Management of ASUS PAP - ASC-US and up require reflex HPV testing for high risk types - if negative can repeat in 12 months if + then send for colposcopy. High risk types, 16 and 18 Treatment of Fibrocystic breast disease? - NSAIDs - Heat or ice - Supportive bra - Decrease caffeine/chocolate What is contraindicated in a patient with placenta previa? - Digital exam Most common type of breast cancer - Infiltrating Intraductal Carcinoma (IIC) 80% Recommendations for breast cancer screening - USPSTF guidelines - baseline mammogram every 2 years from age 50-74y. Every 2 years beginning at age 40 if increased risk factors - 10 years prior to the age the 1'st degree relative was diagnosed. Clinical breast exam: every 3 years in women age 20-39y then annually after age 40 Breast self exam - monthly beginning at age 20 - immediately after menstruation or on days 5-7 of the menstrual cycle What is the key differentiating feature of placenta previa from abruption? - Previa is painless What day of the menstrual cycle is best for breast exam - immediately after menstruation or on days 5-7 of the menstrual cycle Treatment for breast abscess? - I & D and antibiotics (e.g. cephalexin) What medication decreases blood loss by stimulating contractions? - Oxytocin What is the leading indication for cesarean section? - Dystonia Retraction of the delivered head against the maternal perineum - Turtle sign - sign of shoulder dystocia Most common organism in bacterial vaginosis? - Gardnerella vaginalis When is endometritis most common? - After C-section or PROM for more than 24 hours before delivery What is the first line treatment for endometritis? - Clindamycin + gentamycin What defines the triad of pre-eclampsia? - hypertension, proteinuria, edema Preeclampsia is defined as hypertension, proteinuria, and edema with onset after 20 weeks of gestation. What underlying disorders must be considered in a patient with recurrent candida vaginitis? - Diabetes - HIV - Immunocompromise A 28-year-old P1G0 pregnant female presents for a prenatal visit at 37 weeks. The pregnancy has been unremarkable thus far. Her blood pressure (BP) is 148/94 mm Hg, and urine dipstick shows +1 proteinuria. After further monitoring, her BP remains elevated. What would be the most appropriate treatment option? - Schedule the patient for an induced vaginal delivery This patient has mild preeclampsia. Delivery is the only cure, and can be accomplished after 36 weeks. A C-section is not necessary unless complications develop. Which types of HPV virus are most highly associated with cervical cancer? - HPV types 16 & 18 A patient presents at 30 weeks gestation with a blood pressure of 164/118 mm Hg, and complains of nausea and upper abdominal pain. Urine dipstick demonstrates 3+ protein and lower extremity edema is present. No seizure activity has occurred. What is the most likely diagnosis? - Severe preeclampsia This scenario meets the criteria for severe preeclampsia - severe preeclampsia is defined by a BP 160/110 with proteinuria 5g/24 hours or 3+ on dipstick Which types of HPV virus frequently cause Condyloma acuminata? - HPV types 6 & 11 Treatment for genital herpes? - Acyclovir valacyclovir or famciclovir What causes genital herpes? - Herpes simplex virus (HSV) type 1 or 2 Repetitive late decelerations in the presence of 2 contractions in 10 minutes - Represents a positive contraction stress test and warrants prompt delivery Treatment of Syphilis in early stages ( 1 year)? - Penicillin G 2.4 million units X 1 Single painless chancre of the genitalia? - Primary Syphilis Treatment for chancroid? - Azithromycin ceftriaxone or ciprofloxacin Painful ulcerated lesion on vulva or perineal area? - Chancroid The first stage of labor is considered complete when the cervical OS opening measures how many centimeters? - 10 cm The second stage of labor starts with full cervical dilation: 10 cm Name the syndrome in which a patient with pelvic inflammatory disease develops RUQ pain pleuritic chest pain and a tender liver. - Fitz-Hugh-Curtis syndrome What is the normal respiratory rate in a newborn - 30-60 breaths per minute What is the definition of "full-term" - Between 37 and 42 weeks of pregnancy *A pregnancy is "full term" only in the narrower two-week window that starts at 39 weeks, under new definitions published in the journal Obstetrics & Gynecology and endorsed by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. The groups say babies born within those two weeks do best. Babies born two weeks before or one week after that window, at "early term" or "late term," face a few more risks. What are the potential complications of gonorrhea infection? - Pelvic inflammatory disease - Septic arthritis - Perihepatitis - Infertility Name the common causes of cervicitis. - Chlamydia - Gonorrhea - Trichomonas - Herpes - HPV Pap smear comes back with ASCUS. What's next step? - HPV testing What must be considered in female patient complaining of feeling a bulge in the vagina and pelvic pressure? - Uterine prolapse - Cystocele Most common surgical treatment for symptomatic leiomyoma? - Hysterectomy Symptoms seen in patients with Leiomyoma? - Range from asymptomatic to irregular/abnormal-heavy uterine bleeding pelvic pressure/pain back pain urinary symptoms Most common solid benign pelvic tumor in women? - Leiomyoma (Uterine fibroids) Treatment options for endometriosis? - NSAIDs - Oral contraceptives - Danazol - GnRH agonists (e.g. leuprolide) Growth of endometrial tissue/stroma outside of the uterus in aberrant locations? - Endometriosis How do you diagnose endometrial cancer? - Endometrial biopsy Vaginal bleeding in a post-menopausal women is _______ until proven otherwise? - Endometrial cancer List the treatment options for premenstrual syndrome? - NSAIDs - Selective serotonin reuptake inhibitors - Oral contraceptives - Calcium - Exercise What do the following define? Weight gain edema mood changes breast tenderness 1-2 weeks before menstruation? - Premenstrual Syndrome Name 2 preferred treatments for dysmenorrhea - NSAIDs - Oral contraceptives Define primary amenorrhea. - Absence of menstruation by age 16 When is the luteal phase of the menstrual cycle? - Days 15-28 When is the follicular phase of the menstrual cycle? - Days 1-14 Medication used to induce ovulation? - Clomiphene What is likely in a non-pregnant female with galactorrhea and visual field loss? - Pituitary adenoma Organism that causes Chancroid? - Haemophilus ducreyi What is the most common organism that causes mastitis? - Staph aureus What organism causes syphilis? - Treponema Pallidum Lifetime risk for women for developing breast cancer? - 1 in 8 (12%) Second leading cause of cancer death in women? - Breast cancer Most common organism seen with toxic shock syndrome? - Staph aureus Name common causes of secondary amenorrhea. - Pregnancy - Thyroid disease - PCOS - Medication/drugs If uterine massage fails to stop postpartum hemorrhage, what medications may be used? - Oxytocin - Methylergonovine - Carboprost tromethamine What is the mode of delivery for a complete placenta previa? - C-section A patient at 39 weeks gestation has abdominal pain and vaginal bleeding. Fetal monitoring shows a heart rate of 70. What is the most likely diagnosis? - Abruptio placentae What is most likely with absent fetal heart tones, vaginal bleeding and a beta HCG level lower than expected for gestation? - Spontaneous abortion A 31 year old had her LMP 6 weeks ago and has a beta HCG level of 100,000. Ultrasound shows a "snowstorm pattern". What is the most likely condition? - Gestational Trophoblastic Disease What condition should patients who have recurrent 2nd trimester miscarriages be evaluated for? - Incompetent cervix A 28 year old pregnant patient presents concerned about "leaking" fluid. The fluid has a positive Fern test. What is the most likely diagnosis? - Premature rupture of membranes A pregnant patient has a 2 hour blood glucose of 104 on her glucose tolerance test at 28 weeks. What is the most appropriate next diagnostic test to order? - 3 hour glucose tolerance test What is the most likely condition in a patient who has a fundal height and an alpha-fetoprotein which are greater than expected for her due date? - Multiple gestation An expectant mother has a blood type of B positive. How should you manage her case in regards to Rh incompatibility? - No concern (Rh positive mothers will not have Rh incompatibility) A 29 year old female is O negative. The father has AB positive blood type. What complication of pregnancy is she at risk for? - Rh incompatibility What is a normal fetal heart rate? - Normal fetal heart rate is 120-160 - 120 for 10 minute = bradycardic - 160 for 10 minutes = tachycardic What are the three findings which are consistent with fetal asphyxia? - Evidence on neonatal neurological sequelae - pH 5 minutes A newborn is pink, has a heart rate of 110, good respiratory effort, some flexion and grimaces when suctioned. What is the APGAR score? - 8 What is a turtle sign during delivery and what does it indicate? - Shoulder dystocia (Turtle sign-retraction of the delivered head against the maternal perineum) What are some risk factors which would increase the chance for shoulder dystocia? - Fetal macrosomia - Diabetes - Maternal obesity - Postdate pregnancy - Prolonged second stage of labor A 26 year old pregnant female at 39 weeks with regular contractions is 5 centimeters dilated and 50% effaced. What phase of Stage 1 labor is she in? - Active Phase Which stage of labor consists of complete dilation of the cervix to delivery of the fetus? - Second stage A 23 year old pregnant female presents for her prenatal visit. What should be checked at every prenatal visit? - Fetal movement - Blood pressure - Fundal height - Fetal heart tones - Urinalysis Is the cause of infertility more likely to be a female factor or a male factor? - 65% of infertility is due to a female factor What specific preconception counseling should be given regarding folic acid? - Folic acid should be supplemented at a minimum of 400 mcg A 27 year old woman presents concerned she is infertile. What is the period of time she must actively attempt to get pregnant before she can be considered for infertility testing? - 12 months A 26 year old female presents concerned about white milky bilateral nipple discharge. What are the initial indicated laboratory tests? - Prolactin - TSH - betaHCG What is considered to be the gold standard for screening patients for breast cancer? - Mammogram How does a patient's history regarding pregnancy, menarche and menopause affect her chances of developing breast cancer? - Nulliparity, early menarche and late menopause all increase breast cancer risk A 24 year old female has a painless, firm, rubbery unilateral breast mass. Ultrasound shows a solid lesion, Bx is negative. What is the most likely diagnosis? - Fibroadenoma What is the most common causative agent in a patient with a breast abscess? - Staphylococcus aureus What antibiotics may be considered in a patient with mastitis and concern for MRSA? - Clindamycin or trimethoprim-sulfamethoxazole A 68 year old female is diagnosed with a rectocele. What conservative treatment would you recommend? - Kegel exercises - Pelvic floor retraining - Behavioral changes - Bowel regimen A 74 year old female presents with bulging of the anterior wall of the vagina on exam and voiding dysfunction. What is the most likely diagnosis? - Cystocele A 50 year old female has a descended uterus with the cervix positioned beyond the hymen. What grade is her uterine prolapse? - Grade 3 What type of vulvar neoplasm is associated with lichen sclerosis, vulvitis, Paget's and psoriasis? - Differentiated vulvar intraepithelial neoplasm How does vaginal pH affect a woman's chance of getting bacterial vaginosis? - Increased pH (4.5) increases the chance of getting bacterial vaginosis How does vaginal pH affect a woman's chance of getting vaginal candidiasis? - Lower pH (4.5) increases the chance of vaginal candidiasis A 28 year old female presents with finds small flesh colored "cauliflower-like" painless lesions. What is the most likely causative agent? - Human Papillomavirus (HPV) Name two oral treatments given for vaginal herpes? - Acyclovir and valacyclovir A 22 year old female presents with clear genital blisters which open to form multiple coalescing shallow ulcers. The ulcerated areas are painful. What is the most likely diagnosis? - Genital Herpes A 28 year old female presents with two painful ulcerated genital lesions and inguinal lymphadenopathy. What is the most likely causative agent? - Haemophilus ducreyi (Chancroid) What is the name of the syndrome in which a patient with pelvic inflammatory disease has right upper quadrant pain, pleuritic chest pain and a tender liver? - Fitz-Hugh-Curtis An 18 year old female with a history of recent unprotected sex has purulent vaginal discharge and dysuria. What is the appropriate treatment? - Ceftriaxone and azithromycin to cover both gonorrhea and chlamydia A 23 year old female presents with frothy grey-white malodorous discharge. Wet prep finds flagellated protozoa. What treatment is indicated? - Metronidazole or tinidazole for patient with trichomonas When should a woman have her first Pap smear? - At age 21 as of the 2012 guideline update A 22 year old female has a history of an ASC-US PAP and HPV positive test. Which cancer does she have an increased risk for developing? - Cervical cancer A 25 year old female has an ASC-US PAP and HPV positive test. What is the most appropriate next step? - Colposcopy A 27 year old female has Atypical Squamous Cells of Undetermined Significance (ASC-US) on her PAP. What test should be ordered next? - HPV by hybrid 2 capture The mother of a 12 year old female patient is inquiring about HPV vaccine? Is her daughter eligible for the vaccine? - Yes. Ages 9-26 are eligible for vaccine What type of ovarian neoplasm will have Micro-Schiller-Duval bodies seen on histology? - Yolk sac/Endodermal Sinus Tumor What type of ovarian cyst will have hemosiderin laden macrophages on histology? - Chocolate cyst (endometrioma) What type of ovarian cyst can cause carcinoid syndrome? - Teratoma A 23 year old female has oligomenorrhea and hirsutism. Pelvic US shows enlarged ovaries with a "string of pearls" appearance. What is the likely diagnosis? - Polycystic Ovarian Syndrome What is the most likely cause of excessive uterine bleeding with no demonstrable organic cause? - Anovulation or endocrine abnormality How does a woman's endometrial cancer risk change in respect to her history of pregnancy, her age of menarche and her age of menopause? - Nulliparity - Early menarche - Late menopause all increase endometrial cancer risk Almost all uterine fibroids are benign. What type of cancer occurs in the case of a malignant fibroid? - Leiomyosarcoma What bone disorder must be screened for all postmenopausal women? - Osteoporosis What two pathogens are most commonly associated with toxic shock syndrome? - Staphylococcus aureus or Group A streptococcus What is the first line antibiotic for a septic patient with toxic shock syndrome from a retained tampon? - IV clindamycin Which type of dysmenorrhea usually occurs shortly after menarche? - Primary dysmenorrhea Which type of dysmenorrhea occurs mostly later in life? - Secondary dysmenorrhea A 26 year old female has painful periods after she had recovered from a pelvic infection. Is her dysmenorrhea considered to be primary or secondary? - Secondary Patient has active HPV lesions what is the baby at risk for developing - The child may develop warts on his vocal cords and other areas sometime in infancy or childhood. This condition is called recurrent respiratory papillomatosis, is very serious, but fortunately it's also rare Primary amenorrhea is defined as the absence of menses by what age? - Primary amenorrhea is defined as absence of menstruation by age 16 Absence of menses for 3 months in a woman *with previously normal menstruation* or 6 months in a woman with a history of irregular cycles - Secondary amenorrhea Uterine pain around the time of menses. *Pain occurs with menses or precedes menses by 1 to 3 days. Pain tends to peak 24 h after onset of menses and subside after 2 to 3 days.* - Dysmenorrhea *One of the following symptoms is present during the 5 days before menses and abates within 4 days of the onset of menses* - breast tenderness, abdominal bloating, headache, edema, irritability, depression, angry outbursts, anxiety, social withdrawal, and confusion - Premenstrual syndrome Clinical - *absence of menses for greater 12 months, FSH 30* - Menopause *A severe, sometimes disabling extension of premenstrual syndrome (PMS)*. Causes marked disruption in functioning - Premenstrual dysphoric disorder (PMDD) What physical exam findings are most important in determining the cause of primary amenorrhea? - Development of sexual characteristics What's the DX? Primary amenorrhea *XO karyotype, webbed neck*, broad chest, high FSH - Turner's syndrome What's the DX? Primary amenorrhea 46, XY, *high testosterone*, breast development only - Androgen insensitivity What's the DX? Primary amenorrhea 46, XX, *low FSH, LH* - Hypothalamic-Pituitary insufficiency